Welcome to Professional and Technical Services (PTS) – experts in chemical disinfection for infection prevention. Our goal is to educate and provide you the latest resources related to cleaning and disinfection of environmental surfaces, medical devices and hands. As specialists in disinfectant chemistries, microbiology, environmental cleaning and disinfection, facility assessments and policy and procedure creation we are dedicated to helping any person or facility who uses chemical disinfectants.

Tuesday, December 24, 2013

It's unfathomable that 2013 is almost at a close.In writing this, our last and 52nd blog of
the year Lee and I wanted to review the year and share what we and others think
the Top 10 Talk Clean To Me blogs were.In writing the blog, I'm undecided if you should keep David Letterman's
Top 10 in mind (Lee's pick) or because I'm singing along to Christmas Carols if
perhaps the 12 Days of Christmas or The Sound of Music's "These are a few
of my favorite things" should be the theme song to hum while you read (obviously
I vote for humming!).I'll leave the
decision to you and hope you agree with our Top 10 picks.

10. Burnt Bums Call for Ban on Disinfectants:
Disinfectant residue determined to be the cause for chemical burns on a child's
bottom.Perhaps rather than calling for
a ban on the use of disinfectants and sanitizing agents in schools
perhaps the better alternative is to lobby for the use of disinfectants and
sanitizing agents that do not leave harmful residues behind. For example,
hydrogen peroxide breaks down into water an oxygen - that sounds pretty safe to
me!

9.It’s getting harder and harder to breathe!:Custodians
and cleaners have the highest incidence of work related asthma.What steps do you have in place to reduce the
potential exposure to harmful and potentially asthma causing chemicals?Does your product selection committee
consider safer cleaning and disinfectant options or employ practices and
protocols that will reduce a user’s chance of triggering occupational asthma?

7. Safe, Safer, Safely, Safest – Who knew they were “Bathroom” words!:Safe, Safely, Safer,
Safest, Green, Non-Toxic, Harmless... are wonderfully simple yet descriptive
words that clearly impart in plain English a meaning that the general
population can understand, however, when it comes to adjectives used to
describe EPA registered disinfectants they are banned, they are taboo, they are
to be avoided at all costs and if used....there can be hefty
repercussions.

5. ESKAPE Stops Here!:When it comes to disinfection, antibiotic resistant bacteria should be
no more of a challenge to kill with hospital grade disinfectant than the
non-resistant strains. Ultimately, ESKAPE pathogens can have a major impact on
the treatment options available to healthcare professionals, but in the world
of cleaning and disinfection - it’s just another day at the office.

4. Viruses - They cause more infections than you think!:Did you know that some of the most commonly transmitted viruses are not
killed by the disinfectant you may be using on a day to day basis?Is your infection control program prevention
or intervention based?Infection
PREVENTION measures such as changing of disinfectant solutions or increased
cleaning and disinfection during winter months can certainly be implemented
with relative ease and will contribute to fewer infections.The alternative of course is having to
implement INTERVENTION measures to help combat a viral outbreak!

3. iPads, iPhones and Blackberries….oh My!:Electronic devices such as smart phones,
tablets and portable computers have become increasingly important tools for the
delivery of healthcare services and certainly pose a very serious risk
of becoming contaminated and acting as a source for the transmission of
microorganisms.How then do we develop
and infection prevention program fordevices that were not developed with healthcare use in mind?

2. The Ugly Truth – 24/7, 365 = the optimal time for bacterial growth:The ugly truth is
despite our best efforts hospital associated infections (HAIs) continue to
occur. A research team showed that within 6.5 hrs after cleaning/disinfecting,
the bacterial burden found on bedrails had rebounded back by 30% – 40%!Housekeeping budgets are largely comprised
of man hours, cutting back on housekeeping are perhaps not the best way to save
a facility money.Is anyone brave enough
to go ask for more money in order to hire more cleaning staff and increase the
frequency of cleaning?

1. Cotton – it absorbs more than just water: Did you know
Quats and cotton do not mix?Perhaps
your current VRE or MRSA outbreak is not due to poor cleaning, but due to the
fact that while the name of the product may contain the word "Disinfectant"
the cleaning process you are using may counteract and inhibit the ability for
disinfection to actually occur.

We hope you agree with our Top 10 picks (and if you
haven't read them, we hope you'll take the time to read them now!)Thank you from both Lee and I for your
continued support of the Talk Clean To Me blog!We hope 2014 is full of health and happiness for all!

Wednesday, December 18, 2013

For many, this week may signify the last week of work (or
school) for 2014.Many people are
winding down and preparing for the Christmas holidays (in my case, I'm winding
up as I still have shopping, baking and a TON of wrapping to do!).Assuming like me, your brain needs a break
too I thought this week I would lightened it up and share someone's rendition
of a Christmas classic!

Wednesday, December 11, 2013

Until now, I have never really given much thought to what
may or may not transpire when doing laundry.Certainly, I KNOW if you want to keep your whites white, you DO NOT want
that errant piece of red clothing to be part of the white load.Just as my mother had taught me, I separate
laundry to have a linens load, a whites load, a colours load etc.She DID NOT, however, teach me to have a
separate underwear load.If you keep
reading you'll see where I'm going.....

Last week's blog Cotton - it absorbs more than just water
focused on how cotton cloths absorb Quats and therefore impact
disinfection.It gets worse, SO MUCH
worse. Gerba et al recently published a study in AJIC titled "Microbial contamination of hospital reusable cleaning towels".The focus was not on what was found on the
cloth AFTER using, but what was found on the cloth AFTER laundering and
therefore assumed CLEAN!!!Ten (10)
hospitals participated in the study - 8 of which used cotton cloths, 2 of which
used microfiber cloths.Of the 10
facilities, 9 used a Quat as their daily disinfectant.After last week's blog we know that's a
potential infection prevention and control nightmare.After sampling the "CLEAN" cloths Gerba
and his team found that 93% of the cleaning cloths contained viable
microorganisms EVEN AFTER LAUNDERING!

The microorganisms that were found on the offending
cloths included bacteria that play a significant role in HAIs such as
Klebsiella spp, Pseudomonas spp and Serratia spp.The gross factor (at least to me) was the
fact they found coliform bacteria on the cloths...for those who do not know,
coliform bacteria are universally present in large numbers in the feces of
warm-blooded animals (and humans). Basically there was POOP on the cloths!

The researchers did find that there was a significant
difference in the contamination level found after laundering the cotton and
microfiber cloths with microfibers showing the highest level of bacterial
adhesion.Previously published data has
supported the fact that bacteria adhere more strongly to microfiber cloths
which can have the impact of spreading pathogens to different surfaces as the
microfiber cloths are continually used.In the end, Gerba and his colleagues found that typical laundering
practices are not sufficient to remove viable pathogens from cleaning
cloths.What they could not determine
was if the contamination was due to a breakdown in the laundering process or if
the cloths get contaminated from storage and handling (I am going to hope it's
the latter). The end result is that the Infection Preventionists and
Environmental Services staff need to consider that cleaning cloths could be a
potential reservoir for nosocomial pathogens.

I will admit, I have always questioned the laundering
process at hotels and so I NEVER let the bed covers touch my face.I think perhaps now, with the knowledge that
coliforms can be found on cleaning cloths after laundering I am going to have
to rethink how I sort my laundry.Effective immediately, underwear are GOING TO BE LAUNDERED ON THEIR
OWN....need I say more?

Friday, December 6, 2013

Bath towels, dish cloths, T-shirts and socks made of
cotton have one thing in common - absorbency.Whether it is wicking the water off after we shower, the sweat during
and after a workout or wiping up the spills of water or milk we so frequently
seem to have at my dinner table, many of us turn to cotton in some form.

While microfiber is making in-roads, cotton terry cloth
towels are still very prevalent as the cloth of choice for cleaning and
disinfection within healthcare facilities.Infection Prevention and the Product Selection Committee spend hours
reviewing disinfecting products weeding through the attributes of the various
chemistries, ensuring that they have the list of efficacy claims (the kill
list) to meet the facilities' needs etc.However, in focusing on what a product kills is there any consideration
as to what impact the materials housekeeping uses to clean with will have on
the efficacy of the product?I think
not.

In the October 2013 edition of AJIC, Koenig et al
published an article titled "Decreased activity of commercially available disinfectants containing quaternary ammonium compounds when exposed to cotton towels".As noted in the study
poorly cleaned surfaces have been identified as being a potential reservoir for
pathogens and may be the cause of many healthcare associated infections.Numerous studies have shown that effective
cleaning (and disinfection) is necessary to reduce the risk of HAIs.Disinfectants are an important aspect in
reduction of pathogens so reduction in performance of a disinfectant could play
a significant role in allowing transmission to occur.

The truth is that is the negative impact on efficacy of
Quats by either dilution with hard water and/or exposure to cotton cloths has
been known for some time.Koenig et al
investigated the reduction of Quat concentration resulted from the use of
cotton and microfiber cleaning towels and the impact this reduction would have
on disinfectant performance.The results
were indeed scary.

First the good news, it would appear in this study that
exposure to microfiber cloths did not have an impact on the Quat concentration
and that the products tested retained their full germicidal efficacy.Cotton on the other hand did not fare so well.Exposure of the Quat products tested resulted
in a reduction of Quat concentration by 88.9% within 30 seconds of being
exposed to cotton!Excuse ME!?That would leave only 11.1% of the actual
concentration of Quat needed, tested and approved by the EPA to achieve
disinfection.In fact, when the
researchers tested the efficacy of the Quat solution after exposure to cotton
towels they all failed!They were unable
to meet the level of kill needed to be registered by the EPA as a hospital
grade disinfectant.

I'm not saying that Quats are bad.BUT, this study certainly highlights the fact
that we need to take more into consideration than just what a product kills,
what the cost of a product is and what the material compatibility of a product
is.The impact and cost to a facility
due to HAIs is very real.I think Koenig
et al have done an excellent job in highlighting the fact that when choosing a
disinfectant the process by which a disinfectant will be used must also be
taken into consideration and further research into potential interactions
between the disinfectant and cloth choose to apply the product also needs to be
considered.Particularly if concerned
about reducing HAIs and providing the safest environment for our patients as
possible.

If you use Quats at your facility, I hope you'll run down
to Environmental Services to see what type of cloth is being used.Perhaps your current VRE or MRSA outbreak etc
is not due to poor cleaning, but due to the fact that while the name of the
product may contain the word "Disinfectant" the cleaning process you
are using may counteract and inhibit the ability for disinfection to actually
occur.

Friday, November 29, 2013

Unexplained rashes, sniffles, snot and all the other
lovely body fluids that children can produce are an unfortunate consequence of
being a parent.For some parents,
September signifies the return to school and getting life back in order for at
least the next 10 months.For those of
us in the know, it really just signifies the start of cold and flu season (and
by cold and flu I mean ALL of the viruses out there that cause respiratory or
gastrointestinal infections).

Respiratory Syncytial Virus (RSV) is a virus that infects
the lungs and airways and is considered the most common cause of lower
respiratory tract infections in young children worldwide, with almost all
children having their first RSV infection by two years of age. Similar to the
Flu and Norovirus, RSV follows a seasonal pattern where annual outbreaks occur
during fall, winter, and early spring among urban centres.In the Northern hemisphere, epidemics
generally peak in February and March. Within USA, 100,000 hospitalizations and
4,500 deaths annually are attributed to RSV infections. RSV is also a major
cause of nosocomial infections.

RSV is usually a mild disease that goes away on its own.
In very young children RSV can sometimes lead to serious infections like
pneumonia or bronchiolitis (a swelling of the bronchioles — the smallest air
passages of the lungs).In most
children, RSV usually causes symptoms similar to the common cold: stuffy or
runny nose, cough, ear infections (sometimes), low-grade fever and sore
throat.RSV is most likely transmitted
through direct contact with infectious secretions (via fomites) and/or
large-particle aerosols; however, close contact with infected individuals, or
significant exposure of nasal or conjunctival mucosa with contaminated hands is
required for transmission.

A 2004 study published in Pharmacoeconomics reviewed data
from 2000 and found that nearly 98% of RSV infection-related hospitalisations
occurred in children <5 years old. There were approximately 86,000
hospitalisations, 1.7 million office visits, 402 000 emergency room visits and
236,000 hospital outpatient visits with associated annual direct medical $US394
million!

A more recent study published in the Spring of this year
by Jacobs et al, in the Canadian Journal of Infectious Diseases and Medical
Microbiology developed a model to determine costs of community (CRSV) and
nosocomial RSV infections (NRSV).Similar to stats in the US, 10% of hospitalized patients will acquire a
nosocomial infection of which 71% are due to respiratory viruses!Annual costs of NRSV in Canada for patients
<1yr of age was determined to be about $7.9 Million.The study determined that NRSV added $993 to
each CRSV case and also found if improved infection control procedures were in
place a reduction of transmitted treatment costs of $469/patient could be
attained.What a novel idea - Infection
Prevention programs can help save money!

It's very hard to keep from catching RSV, just like it's
hard to keep from catching a cold.You
can lower the chances by practicing good health habits such as washing your
hands often, and teach your child to do the same.If you're in the Northern Hemisphere and
your child has to be admitted to hospital I hope you'll remember that
respiratory viruses this time of year are just as rampant in hospitals as in
the community.Ask the nurse and doctor
to wash their hands and don't be scared to find a disinfectant wipe to clean
the area you're in!

Friday, November 22, 2013

There are times when the best laid plans go to awry.In keeping on my viral theme for the month I
had planned to talk about a Norovirus outbreak in a pediatric unit that was
caused by healthcare workers.I know I
read the study, but my recall abilities seem to have gone into early
hibernation.Was it late spring, summer
or early fall?I know I was on a
plane.....Regardless, it was a great
example of "inconvenience and irritation" from last week's blog
"The Burden of You and the Flu".

It was also the first time that Google let me down...at
least in finding the study I was looking for.My Google search however, did pop up the Micro Blog which is written by
Jon Otter (@jonotter) and Saber Yezli from the UK.If you're a Infection Prevention nut like me,
follow it.Touted as "Your window
to the world of healthcare microbiology and epidemiology" -Otter and Yezli post some great blogs.

It was the "Domestic Outbreak of Gastroenteritis" that had me chuckling, not at Otter's misfortunes mind
you, but because almost a year ago last night, I lived through the same
thing.Here's the summary of Otter's
outbreak:

"Last Wednesday (let’s call it outbreak day 1), our
18-month old toddler “sprayed” projective vomit around our porch. My wife
cleaned up the mess. On outbreak day 3, 36 hours later, my wife presented
(grumpily) with acute gastroenteritis. We made every effort to limit domestic
horizontal transmission (including regular bleach disinfection of contact
surfaces in the bathroom and cohorting of personal effects) but to no avail; a
little over 24 hours later on outbreak day 4, I endured acute
gastroenteritis."

In the 2012 Kenny Outbreak, our then 3.5yr old projectile
vomited over his bed, the carpet in his room and ME in the wee hours of a
Friday.By Sunday, both my husband and I
were inflicted with the same thing (thankfully we have 3 bathrooms).Our cohorting consisted of taking turns in
parental duty by lying on the couch in the family room to ensure Sawyer was
somewhat safe or sprawling on our bed.I
have never been so happy for the invention of TV, DVDs and pre-packaged food!

The truth is, Norovirus happens.It is irritating.It is an impediment and it is certainly an
inconvenience!It happens everywhere and
especially when you least expect it!As
Otter detailed in an earlier blog about a Norovirus outbreak that was associated with a Car Dealership where the generous mother left the mess for
the staff to clean up using nothing more than dry paper towels, you just never
know when or how you may pick up your next gastro bug!I need to get my car in for servicing...I can
assure you I will never use a car dealership's washroom again!

Monday, November 18, 2013

Depending on your situation in life we look at illness in
many different ways.As an irritant -
your spouse or significant other or your children ALWAYS get sick when you
have the least time to deal with their whining shenanigans.As an impediment -you do not have the time nor the patience to
feel under the weather due to work or family commitments.As an inconvenience - your colleagues insist
upon coming to work or your friends or family insist on coming for a visit
without the forethought that they may spread their illness to you or your
family.

The truth of the matter is that Influenza infections are
costly. They cause substantial morbidity
and mortality and are strain on every country's healthcare resources.However,the impact or burden to our healthcare system varies greatly year to
year depending on the Influenza strains in circulation.The study reviewed lab-confirmed inpatient
characteristics, treatment and outcomes of the pandemic season (2009-2010) with
the prepandemic (2006-2007 & 2008-2009) and postpandemic (2010-2011)
seasons.Of the 2868 cases identified,
629 cases were from the prepandemic season, 1132 cases from the pandemic season
and 1107 cases from the postpandemic season.Of interest was the fact that the healthcare-associated influenza cases
was lower during the pandemic than the pre and post pandemic seasons.Also of interest was the fact that the
Healthcare-associated Influenza cases was higher in acute care facilities than
long term care facilities during the pandemic season as compared with pre and
post pandemic seasons.

With respect to patient characteristics, during the
pandemic season the median age of those inflicted during the pandemic season
was significantly lower than the pre and post pandemic season (hence the lower
infection rates seen in LTC's!).Similarly, during the pandemic season inpatients were more apt to have
pulmonary disease whereas in the postpandemic season they were more likely to
have chronic heart and kidney disease.Possibly as expected, more severe outcomes were reported during the
pandemic season as vaccination rates were lower.

Of particular interest was the impact of infection
prevention and control practices during the pandemic season.With knowledge that vaccines were not readily
available, ensuring effective interventions were in place (hand hygiene,
cleaning and disinfection, isolation etc) likely helps limit
healthcare-associated transmission.If
this is true, then the ugly truth is that the increase of healthcare-associated
infections in the postpandemic season could be directly related to a lapse and
complacency around in infection prevention practices.

We cannot underestimate the flu and its significant
impact on the resources needed to effectively limit its spread.Being prepared to combat Influenza should not
be relegated as a response to an outbreak or a pandemic.The threat of infection and the threat of
transmission is an ongoing annual concern and should be an automatic response
on a daily basis during Flu Season.Influenza is an enveloped, easy to kill virus.Ensuring that environmental surfaces and
patient care equipment are cleaned and disinfected daily (and of course after
each patient use!) will go a long way to minimizing transmission from
environmental surfaces.Of course,
getting vaccinated and washing your hands helps too!

Wednesday, November 6, 2013

I'm not one for themes - well unless it comes to planning
birthday parties: CARS, Angry Birds or surprise parties for "big"
milestones.In writing our weekly blogs,
Lee and I have tried to weave a story about the use of disinfectants for
infection prevention.However
unintentional, this month, as I plan out topics for the blog, I'm seeing a
theme develop - viruses.

In part the reason for developing theme is an article I
read that was published in the October edition of AJIC by Tzialla et al titled
"Viral Outbreaks in neonatal intensive care units: What we do not know".Not unexpectedly, infants
admitted to NICUs are at risk for contracting HAIs and certainly over the past
decade, the HAIs rates have steadily increased.However, the vast majority of outbreaks published in scientific studies
focus on bacterial or fungal infections and certainly they do account for a
significant portion of the outbreaks, the impact of viruses as nosocomial
agents are not well documented.

Tzialla et al queried an outbreak database and found a
total of 75 neonatal outbreaks of which 64 were directly related to neonatal
patients and 44 (>68%) associated with NICUs.The top 5 causative agents were: Rotavirus
(>23%), RSV (>17%), Enterovirus (>15%), Hepatitis A (>10%) and
Adenovirus (>9%) with gastrointestinal system infections accounting for
>54% of outbreaks and respiratory tract infections accounting for
>34%of the infections.

From an infection prevention perspective, is there a
common theme?

• From a microbiological perspective, Rotavirus,
Hepatitis A, Enteroviruses and Adenoviruses are non-enveloped viruses.They tend to be hardier viruses that are more
resistant to traditional disinfectant chemistries such as quaternary ammonium compounds.

• From a transmission perspective, Rotavirus,
Enterovirus, Hepatitis A and Adenovirus can be transmitted via fecal-oral route
- meaning the poor little neonate is eating poop!

• From a transmission perspective RSV, Adenovirus and
Enterovirus are transmitted by contact with respiratory droplets.

• Transmission from contact with environmental surfaces
and/or fomites has been documented.

• Many of these viruses increase circulation during the
fall, winter and early spring.

We are well into Fall and what we typically call Flu Season, in fact there are only 46 more days until the first day of winter!While we often plan well in advance for
Halloween, the Canadian and US Thanksgiving and Christmas holidays (there are
only 49 more days to shop!), do we consider planning for "Virus
Season"?Are there preventative
measures we can and should consider putting into place?When was the last time you reviewed the
efficacy claims of the daily disinfectantyour facility uses?Does your
product carry claims against Influenza, Norovirus, Rotavirus, RSV, Enterovirus,
and Adenovirus?Do you have an infection
prevention plan that considers making a change to a more efficacious product to
help in the prevention of viral outbreaks?Do you increase the frequency with which high-touch hand contact
surfaces are cleaned and disinfected in order to reduce the risk of
transmission from contact with these surfaces?Do you have a readily accessible Fact Sheets that can be reviewed with
staff to help them identify when they may be ill to help minimize the risk that
staff are the source of the outbreak?

A fulsome program that considers (and hopefully
implements) infection PREVENTION measures such as changing of disinfectant
solutions or increased cleaning and disinfection can certainly be implemented
with relative ease and likely contribute to fewer infections.The alternative of course is having to
implement INTERVENTION measures to help combat a viral outbreak!

Thursday, October 31, 2013

The ugly truth is that Summer is over, Fall is upon us
and with that is the start of Flu and Norovirus season.While the Flu season does not typically peak
until January-February, we have entered into what we consider the "FLU
SEASON" (read with the Twilight Zone theme song in mind) and truly never
know when we may start to see cases or outbreaks of Influenza within hospitals,
long term care facilities or schools pop up.

The fact that my son has come down with his first
"viral" infection of the Fall and I just finished reading an article
by Wong et al published in Pediatrics titled "Influenza-Associated Pediatric Deaths in the United States, 2004−2012" seemed a good enough
reason to tackle infection prevention practices for the flu.But first, let me highlight some of the facts
uncovered in the study:

1. Between 2004 & 2013 the CDC logged 830 flu deaths
in children younger than 18.

2. 43% of the children who died, did not have underlying
conditions that put them at risk for flu complications.

3. A disproportionate number of flu deaths were seen in
kids with underlying conditions such as asthma (there are currently 7.1 Million
children in the US who have asthma).

4. Previously healthy youngsters appeared to die more
quickly than those who had underlying conditions—one-third died within 3 days
of symptom onset.Pneumonia was the most
frequent complication.

5. Few of the children who died were vaccinated against
flu.

First off, the flu is NOT a gastro or intestinal
bug.Influenza is a highly contagious
respiratory disease caused by an Influenza virus.Unlike the common cold, the flu usually comes
on suddenly and most people will often feel some or all of these symptoms:

• Fever or feeling feverish/chills (but not EVERYONE will
have a fever)

• Cough

• Sore throat

• Runny or stuffy nose

• Muscle or body aches

• Headaches

• Fatigue (tiredness)

• Some people may have vomiting and diarrhea, though this
is more common in children than adults.

People with flu can spread it by coughing, sneezing or
TALKING to others up to about 6 feet away!The droplets "excreted" by someone carrying the flu can land
in the mouths or noses of people who are nearby or possibly be inhaled into the
lungs.People can also get flu by
touching a surface or object that has flu virus on it and then touching their
own mouth or nose.

1. Cleaning:Environmental surfaces should be cleaned and disinfected frequently with
an EPA or Health Canada approved disinfectant.Access to Pre-moistened wipes that can be easily used without need for
PPE is a great way to include not just nursing and environmental services staff
as the primary parties for cleaning and disinfection.Visitors, patients and students (for schools)
can also do their part in helping to keep the environment clean and flu free!

2. Hand Hygiene: Wash hands often with soap and water. If
soap and water are not available, use an alcohol-based hand rub.

Tuesday, October 22, 2013

This week is International Infection Prevention Week
(IIPW) around the world. As many of you
will know from reading past blogs, Infection Prevention and Control programs
have been widely recognized as a corner stone to preventing and controlling the
spread of infections both within the community and within healthcare
facilities.IIPW is a week to not only
promote infection prevention practices but celebrate with healthcare workers
for the work and efforts put forth the other 51 weeks of the year to stop the
spread of infection.

There are a number of educational webinars and other
educational materials available:

While IIPW is often focused towards healthcare settings,
there is nothing to stop those of us who work in non-healthcare areas to
celebrate IIPW.There are numerous fun
and educational games or activities that can be tailored to any facility.A hand washing competition using Glo-Germ (UV
reflective goo), regardless of where you work is always entertaining!Or with the increased usage of ATP meters,
activities such as “who has the dirtiest cell phone or keyboard” can also open
one’s eyes as to the need for cleaning and disinfection of the surfaces we
touch and use frequently throughout the day.

Test your Infection Prevention knowledge with the
following questions.

If you post your
answers on the blog and we'll let you know how well you did!

True or False:

1. To disinfect for pathogens such as bacteria or
viruses, spray or wipe the disinfectant on to the surface to be disinfected and
let air dry.

2. Cleaning with a disinfecting agent will remove
pathogens no matter how you use it.

3. The most common route of bacteria transmission is
contaminated surfaces.

Word Scramble:

4. Your best defense against infection is:AHDN EGNYEHI

5. The name of the virus that causes respiratory
infections typically between the months of November and April:UZILANNFE

Perhaps next year we can have an Infection Prevention
joke off?Do you think I'd win with
this?

Sunday, October 20, 2013

Copper is the oldest metal known to human civilization,
and dates back to about 10,000 years. Silver mining also started about 5,000
years ago, where silver was used as a value resource and coinage. Antimicrobial
effects of both metals have been utilized long before the concept of microbes
became reality. Containers with an external layer of silver or copper were used
to keep water fresh and food from spoiling. Silver coins were also dropped into
milk containers to prevent milk from spoiling quickly. Direct use of copper and
silver as antimicrobials started only in the recent decades. Disinfectant
solutions containing colloidal copper or silver ions are used to treat hard
surfaces. An external layer of copper is used on certain high-touch surfaces in
healthcare settings to aid in prevention of microbial cross-contamination.
Certain soft surfaces, such as fabrics, are also impregnated with silver nanoparticles
to control and minimize the growth of odor causing bacteria.

Based on the chemical properties of silver or copperions
in solution, such disinfectants by themselves would have no cleaning power,
unless additional surfactants and soaps are added to the formulation. In
general, both metal ions are cytotoxic to pathogenic bacteria. Free silver ions
disrupt the functional properties of active proteins such as enzymes. This
change would cause alteration of the 3D structure of proteins and therefore
result in loss of function. Silver is also hypothesized to damage DNA
structures. Copper is known to interact with active proteins in microbial cells
and therefore interrupt their functions, resulting in microbial death. Copper
ions are also thought to interact with membrane lipids which results in
rupturing of the microbial cells.

These metal ions can in additionally affect viruses, as
viruses also have protein and lipid structures on their external shell.
Resistant strains of pathogens have been known to combat against the metal ions
by either preventing their entry into the cell, or through mutations that
result in change of their protein surfaces.

Silver oxidation does occur slowly. Disinfectant
solutions containing colloidal silver care exposed to gradual oxidation, which
would eventually cause them to crash out of the solution and precipitate. Once
out of solution, they no longer are available to interact with microbial cells.
Antimicrobial surfaces covered with copper coatings also undergo oxidation.
Such antimicrobial hard surfaces are in fact affected by oxidation and
deposition of organic soils on the most surface layer of copper. Organic soils
and oxidized ions can act as a barrier layer and prevent the surface microbes
from touching and interacting with the silver or copper layers. Therefore, the
surfaces have to be cleaned and kept residue free in order to be effective
against pathogens. Copper and silver coated surfaces also impose compatibility
problems when they are to be disinfected with various cleaner disinfectant
agents. Such incompatibilities may arise in forms of corrosion, or immediate
formation of an oxidized film layer that either degrades the surface or
decreases the efficacy of those against pathogens.

Continuous exposure of humans to solutions with colloidal
silver can result in deposition of silver particles inside the skin cells. Over
a very long exposure time and over-accumulation, it can cause a condition
called Argyria, which is discolouration of skin into a blue-gray colour.

Both copper and silver, especially silver, are extremely
harmful to the environment. Silver is known to have high aquatic toxicity as it
can bioaccumulate in marine organisms’ tissues. Therefore, proper disposal of
disinfectants containing colloidal silver or copper are often problematic, as
the intent is to prevent its flow to open waters and oceans.

Here’s how we would score Silver and Copper on the key
decision making criteria for antimicrobial surface agents:

• Speed of Disinfection – N/A

o Use of Silver and Copper provides continuous reduction
and inhibits growth of pathogens on surfaces (e.g. over extended periods of
time from 2 - 24hrs)

• Spectrum of Kill – C

o Efficacy against bacteria and viruses has been shown
but is dependent upon the metal ions being able to directly contact the
pathogen

• Safety Profile – B - C

o Prolonged to silver can lead to bio-accumulation on
skin and lead to health concerns

• Environmental Profile – D

o Both copper and silver and known to be extremely
harmful to the environment

o Silver in particular has high aquatic toxicity and can
bioaccumulate in tissues

• Cost Effectiveness – D

o Such products are still in their infancy, facilities
need to weigh the cost of use versus benefit to infection reduction

Friday, October 11, 2013

I'm almost getting too paranoid to travel.In August I blogged about the Cyclospora
outbreak that was affecting 16 states and linked back to lettuce used by
several restaurant chains including one that I had eaten at while on a trip to
Michigan and Massachusetts.I just got
back from San Fran on Sunday and wouldn't you know it, by Monday I was reading
about a Salmonella outbreak that is currently circulating around 17 states
across the US with California being the hardest hit.I was under the weather for a few days while
on this trip.I did eat some chicken
while there, but can't say that food was the true cause.

As of October 7, 2013, a total of 278 persons infected
with seven outbreak strains of Salmonella Heidelberg have been reported from 17
states.Of these cases, 42% of ill
persons have been hospitalized, but no deaths have been reported. Illness onset
dates range from March 1 to September 24, 2013 with a range in age from <1
year to 93 years.The median is age of
20 years and 51% percent of ill persons are male (can we say beer, chicken
wings and Monday Night Football?).

The on-going outbreak investigations conducted by local,
state, and federal officials indicate that consumption of Foster Farms brand
chicken is the likely source of this outbreak of Salmonella Heidelberg
infections. The outbreak strains associated with the outbreak are resistant to
several commonly prescribed antibiotics which may be associated with an
increased numbers of hospitalizations seen thus far.While it is not unusual for raw poultry from
any producer to have Salmonella bacteria, it is uncommon to have
multidrug-resistant Salmonella bacteria.

Salmonellais a
rod-shaped, gram-negative, non-spore-forming bacteria.In the US, there approximately 42,000 cases
of salmonellosis reported each year, but because many milder cases are not
diagnosed or reported, the actual number of infections may be twenty-nine or
more times greater.Most persons
infected with Salmonella bacteria develop diarrhea, fever, and abdominal cramps
12 to 72 hours after infection. The illness usually lasts 4 to 7 days, and most
persons recover without treatment. Salmonella bacteria can survive for weeks
outside a living body, and they are not destroyed by freezing.

Salmonella can be transmitted both by direct and indirect
contact through a number of ways as listed below, but basically, you're eating
poop:

• Infected or contaminated food;

• Poor kitchen hygiene, especially problematic in
institutional kitchens and restaurants because this can lead to a significant
outbreak;

• Excretions from either sick or infected but apparently
clinically healthy people and animals;

• Polluted surface water and standing water (such as in
shower hoses or unused water dispensers);

In healthcare facilities, high touch surfaces are often
contaminated with nosocomial pathogens, and may serve as vectors for
cross-transmission.While Salmonella is
typically associated with eating of contaminated food a study that investigated
the degree of pathogen transfer from contaminated surfaces to hands showed that
transmission to hands occurred 100% of the time with Salmonella spp.,
Escherichia coli, and Staphylococcus aureus.As hand hygiene compliance rates for healthcare workers is around 50 %
at best, the risk of transmission from contaminated surfaces cannot be
overlooked.

The best way to avoid any type of direct contact with
Salmonella is to immediately wash your hands and all contaminated surfaces
after every use. Surfaces that are reused in the kitchen such as countertops
and food prep areas should be cleaned and sanitized in order to kill off
bacteria.Surfaces within a patient's
room infected with Salmonella should be cleaned and disinfected daily and
healthcare workers and visitors should be vigilant with hand hygiene.

Let's hope that thawing a turkey in a cooler is
considered hygienic!I'd hate to be the
cause of a Salmonella outbreak at the Canadian Thanksgiving Dinner I'm hosting
on Saturday....